Management of Small IV Infiltration (2cc)
For a very small IV infiltration of approximately 2cc without signs of severe complications, immediately discontinue the IV, remove the catheter, elevate the affected extremity, and apply cold compresses for 15-20 minutes every 4 hours for 24-48 hours, with close monitoring for progression over the next 24-48 hours. 1
Immediate Actions
Stop the infusion immediately upon recognition of infiltration, as delay in catheter removal can worsen tissue damage 2, 1:
- Disconnect the IV tubing from the cannula 1
- Aspirate any remaining fluid from the cannula if possible 1
- Remove the peripheral venous catheter completely 2
- Inspect the site visually to assess extent of swelling, erythema, or discoloration 3
Initial Treatment Protocol
Apply cold therapy as first-line supportive care for non-vesicant infiltrations 1:
- Apply ice packs or cold compresses to the affected area 3, 1
- Use 15-20 minute applications, repeated every 4 hours for 24-48 hours 1
- Cold therapy promotes vasoconstriction and theoretically limits fluid dispersion into surrounding tissues 1
Elevate the affected extremity above heart level to promote fluid reabsorption and reduce swelling 1
Monitoring Requirements
Assess the infiltration site closely over the next 24-48 hours for signs of progression 4, 1:
- Monitor for increasing pain, swelling, or skin discoloration 3
- Check for signs of infection (warmth, erythema, purulent drainage) 2
- Evaluate for skin breakdown, blistering, or necrosis 4
- Document the infiltration with date, time, approximate volume, and infusate type 3
Expected Outcomes for Small Infiltrations
Most small infiltrations resolve without complications with conservative management 4:
- In a large retrospective study of 495 infiltrations, only 8.6% developed superficial infection, 3.2% developed necrosis, and 1.9% developed ulceration 4
- Zero cases resulted in compartment syndrome, and only 5.1% resulted in any long-term defects 4
- A 2cc infiltration falls well below volumes typically associated with serious complications 4
When to Escalate Care
Consult a specialist if any of the following develop 4, 1:
- Progressive swelling beyond the initial infiltration area
- Skin necrosis, eschar formation, or full-thickness wounds 4
- Signs of compartment syndrome (severe pain, paresthesias, pallor, pulselessness)
- Persistent pain lasting more than 10 days 3
- Development of infection requiring systemic antibiotics 2
However, surgical emergencies from small infiltrations are extremely rare - in the study of 495 infiltrations, no emergent surgical interventions were required, and only 1.4% needed any operative management 4
Site Care After Infiltration
Clean the area with appropriate antiseptic if there are any breaks in skin integrity 2:
- Use 2% chlorhexidine-based preparation or 70% alcohol 2
- Apply sterile gauze dressing if site is weeping or oozing 2
- Keep the area clean and dry 2
Prevention for Future IV Access
Avoid placing the next IV in the same extremity until the infiltration has completely resolved 2:
- Select upper extremity sites preferentially 2
- Avoid placement over joints or in areas with limited subcutaneous tissue 3
- Consider midline catheter if IV therapy will exceed 6 days 2
- Replace peripheral IVs every 72-96 hours in adults to reduce phlebitis risk 5, 2
Common Pitfalls to Avoid
Do not apply heat to the infiltration site unless specifically treating certain vesicant extravasations (which require drug-specific protocols) 1 - for routine infiltrations, cold therapy is preferred 3, 1
Do not delay catheter removal once infiltration is recognized, as continued infusion worsens tissue damage 2, 1
Do not routinely consult specialists for small, uncomplicated infiltrations - approximately 75% of infiltrations can be managed by primary teams without specialist involvement 4
Do not submerge the affected area in water until complete healing has occurred 2